Exam 3 CNS Flashcards by Heidi G

What is GFAP?

Glial fibrillary acidic protein. it is a protein that astrocytes make when injury detected in the brain

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T/F GFAP is collagen

False

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What is the function of oligodendrocytes?

to myelinate axons and provide insulation to propogate action potential going down the axon

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These cells are resident macrophages of the brain

a. oligodendrocytes
b. astrocytes
c. neurons
d. microglial cells

D. microglial cells

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What is the function of microglial cells:

To clear damage - phagocytic and they migrate to areas of damage

when there is damage, they proliferate

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What does a stroke look like on stain?

very large amount of cytoplasm and bulbbly because full of lipid material = full of myelin

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If the BBB is damaged, what happens to the brain

it swells

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What are the two types of brain swelling?

Vasogenic Cerebral Edema

Cellular/ Cytotoxic Cerebral Edema

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Tx of vasogenic cerebral edema?

Mannitol or Decardon

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This type of edema is caused by fluid entering the extracellular space

a. vasogenic cerebral edema
b. cellular cerebral edema

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What is vasogenic cerebral edema associated with?

a. brain tumor
b. stroke
c. hypertension
d. brain abscess
e. A and D

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This is an untreatable form of cerebral edema
becasue it occurs intracellularly:
a. vasogenic cerebral edema
b. cellular cerebral edema

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What is cellular cerebral edema associated with?

a. brain tumor
b. stroke
c. hypertension
d. brain abscess
e. A and D

B. stroke

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If a person has a mixture of both vasogenic and cellular cerebral edema, will mannitol treat their condition?

a. No
b. yes no matter when they are treated
c. yes, only in the early stages

C. early stages

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What is a possible complication of when the brain over-swells?

transtentorial herniation

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T/F The brain, like most other organs, has a lymphoid drainage system

False, no draining of lymph

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What is hydrocephalus?

build up of CSF in the lateral and 3rd ventricles

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T/F the brain has no glycogen stores

TRUE

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How long does it take you to lose consciousness if you are deprived of oxygen?

a. 15-20 seconds
b. 1-2 minutes
c. 3-4 minutes
d. 5-6 minutes
e. 10 minutes

A. 15- 20 seconds

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At what point do you start losing neurons?

a. 15-20 seconds
b. 1-2 minutes
c. 3-4 minutes
d. 5-6 minutes
e. 10 minutes

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How many ml of O2 per minute do nuerons require?

a. 500-600
b. 75-100
c. 300-400
d. 1000-2000

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This is defined as arrest of or inadequate blood flow

a. anoxia
b. hypoxia
c. ischemia
d. eosinophilic degranulation

C. ischemia

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This is defined as the absence of oxygen:

a. anoxia
b. hypoxa
c. ischemia
d. eosinophilic degranulation

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This is defines as reduced oxygen supply:

a. anoxia
b. hypoxa
c. ischemia
d. eosinophilic degranulation

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How many neurons does the brain have?

100 billion

How much does the brain weigh?

2.5 pounds

This is defined as a sudden loss of neurologic function related to a problem with the cerebral vascular supply

Stroke

What are the two types of stroke

ischemic + hemorrhage

T/F Each 100 g of brain tissue must receive 50 ml of blood per minute

True

What is the difference between an ischemic and a hemorrhagic stroke? a. A hemorrhagic stroke is when there is too little blood and an ischemic stroke is when blood is leaving the vascular spaces b. A hemorrhagic stroke is when blood is leaving the vascular spaces and an ischemic stroke is when there is too little blood c. there is no difference between the two

T/F Stroke is the leading cause of long term disability

True

When the brain is only getting 20 ml/100g, what does the EEG look like? a. normal b. amplitude increased c. amplitude decreased d. isoelectric e. absent

When the brain is getting 15ml/100g, what does the EEG look like? a. normal b. amplitude increased c. amplitude decreased d. isoelectric e. absent

D. isolectric aka no waves, no evoked cortical response & absent electrical activity

In terms of large hemispheric strokes, what is the most common artery that is affected? a. anterior cerebral b. middle cerebral c. posterior cerebral d. all the same

B middle

These are slit like infarcts that are small and typically arise in the basal ganglia (caudate + putamen) that may ALSO occur in the pons in pts with diabetes or hypertension. a. embolic infarcts b. lacunar infarcts c. thrombus in left auricle d. none of the above

B. lacunar

Which of the following are common sources of cerebral embolism? a. ulcerative atherosclerosis of the common + internal carotid arteries b. thrombus in the left auricle in pts w a fib c. acute bacterial endocarditis d. all of the above e. none of the above

These infarcts are peripheral in nature, tend to be multiple + hemorrhagic and can arise from many different sources a. embolic infarcts b. lacunar infarcts

A. embolic

Subarachnoid hemorrhages occur : a. between dura mater + skull b. between dura + epicure c. between dura + pia mater d. between pia mater + arachnoid mater

most common cause of subarachnoid hemorrhages?

berry aneurysms in the circle of willis

Berry aneurysms are related to a defect where?

in the INTERNAL elastic lamina

T/F Berry aneurysms usually appear as one lesion

False, frequently multiple

This type of aneurysm is due to the rupture of blood vessels in the parenchyma of hte brain that quikcly ruptures into the ventricular system and kills the patient a. subarachnoid hemorrhage b. Primary Intracerebral Hemorrhage

b. Primary Intracerebral Hemorrhage

What is the true prevention of Primary Intracerebral Hemorrhages?

Decreased BP!!!

What is the 3rd most common cause of death and leading cause of long term neurologic disability?

Stroke

T/F Berry aneurysms are related to defects in the vessel wall that are probably developmental in nature

TRUE! probably born with it and then it develops in hte mid 20s

What is the primary tumor of the brain?

Astrocytoma (which is a glioma (tumor of glial cells))

A glioblastoma is: a. low grade b. medium grade c. high grade

C high grade

This ring contrast enhacement is seen on a CT or MRI scan and is evident of what? a. glioblastoma b. medulloblastoma c. meningioma d. none of hte above

Glioblastoma! used to diagnose!

What is the tx of glioblastomas?

surgery, chemo or radiation but these are last months, not years

This is a rapidly growing tumor that commonly occurs around the 4th ventricle, causing hydrocephalus a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

b. medulloblastoma

This type of tumor may arise anywhere in the cerebrum, cerebellum or brainstem + is composed primarily of B cells. A HIGH percentage is caused by EBV, survival rate is 3-4 years a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

This is a common, slow growing , non invasive type of tumor that typically presents with seizures. On MRI psammoma bodies are seen a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

C. meningioma

Since these type of tumors dont invade, surgery is the mainstay of treatment for them a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

This tumor can give rise to hyperostosis of overlying skull and is more common in females in the 7th decade a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

C. meningioma

This tumor arises in the vestibular division of hte 8th nerve that causes unilateral deafness a. glioblastoma b. medulloblastoma c. meningioma d. primary cerebral lymphoma e. acoustic neuroma/schwannoma

How do you diagnose schwannomas? a. CT b. XRAY c. MRI d. H&P

c. MRI

``` What is the MOST common site of metastasis to the brain? A. Lung b. breast c. melanoma d. thyroid e. kidney ```

LUNG!!!!!!!!!!!!

Which of the following typically metastasizes to the brain? a. Abdominal carcinoma b. Gynecological cancers c. Prostate cancers d. Pulmonary cacner

D. pulmonary

Pt presents with prostate cancer. After MRI, you find multiple metastases in the brain. Where did he most likely obtain these metastases from? a. His prostate gland b. His GI tract c. His lungs d. The primary tumor was in the brain and spread to the prostate

C. Lungs

What is the MOST common presenting symptom of a metastasis to the brain causing initital symtpoms?

GRAND MAL SEIZURE

T/F ALS is a disease of both upper + motor neurons

TRUE

T/F In ALS the LATERAL CORTICOSPINAL TRACTS (and sometimes the anterior corticospinal tracts) selectively degenerate.

True

What is amyotrophy?

The atrophy of muscles related to LOSS of innervation - need to have neuronal innervation loss for it to be considered amyotrophy

T/F The intellect, sphincter control and sensation of an ALS patient remains intact throughout the course of the disease

True

What is the protein inside the Lewy bodies called?

alpha synuclein

What are the three types of genetic testing for HD?

diagnostic presymptomatic prenatal

T/F The degree of atrophy of an elderly persons brain makes the diagnosis of alzheimers disease

FALSE. there is not enough of a difference from the normal elderly brain to make the diagnosis

What are the two proteins that accumulate in the brain of an alzheimers patient?

Tau = neurofibrillary tangles | beta amyloid plaques

What is the major area where neurons in alzheimers disease degenerate?

Nucleus Basalis meynert aka the basal forebrain

What type of drug is aracept?

Cholinergic drug

What is an uncommon cause of dementia that is categorized by abrupt onset, history of stroke, fluctuating course, focal neurolgic signs an symptoms?

Multi- infarct dementia

Neurofilament? a. alzheimer's b. parkinson's c. ALS d. Huntington's

c ALS

Intranuclear + cytoplasmic inclusions (huntington) a. alzheimer's b. parkinson's c. ALS d. Huntington's

alpha synuclein? a. alzheimer's b. parkinson's c. ALS d. Huntington's

where is the inflammatory response in a person with acute bacterial meningitis?

in the subarachnoid space

With what age group do you see H flu causing meningitis? a. neonates b. children c. epidemics d. elderly

b children - not commonly seen know because of vaccines

With what age group do you see meningococcal meningitis? a. neonates b. children c. epidemics d. elderly

C epidemics

With what age group do you see pneumoccocal meningitis? a. neonates b. children c. epidemics d. elderly

D. elderly

Brain abscesses are commonly seen with?

vasogenic edema

What are the two causes of brain abscesses

Local or hematogenous

Difference btween pathogenic and opportunistic organisms?

``` Pathogenic = every individual Opportunistic = only in pts w decreased resistnace to organisms + pts w pre-existing conditions ```

This is an opportunistic infection that occurs more commonly int he base of the brain (chronic basilar meningitis) a. Mucomycosis b. PMLE c. Cryptococcal meningitis d. Toxoplasmosis e. other fungi

T/F Cryptococcal meningitis ALWAYS spreads from the lungs

TRUE

What does the histology of virtually all forms of viral encephalitis look like?

perivascular chronic inflammatory cell infiltrates

Poliomyelitis is the acute viral attack of what? a. sensory neurons b. muscle c. bone d. motor neurons e. skin

D motor neurons

This is an acute, necrotizing, hemorrhagic infection of the frontal + temporal lobes a. Poliomyelitis b. Herpes Encephalitis c. Rabies d. Arboviral Encephalitis e. HIV f. Progressive multifocal leukoencephalopathy PMLE

This is the MOST common form of acute viral encephalitis in the US a. Poliomyelitis b. Herpes Encephalitis c. Rabies d. Arboviral Encephalitis e. HIV f. Progressive multifocal leukoencephalopathy PMLE

This virus has cowdry A inclusion bodies a. Poliomyelitis b. Herpes Encephalitis c. Rabies d. Arboviral Encephalitis e. HIV f. Progressive multifocal leukoencephalopathy PMLE

This is an opportunistic viral infection that affects oligodendroglia cells and produces multiple foci of myelin damage a. Poliomyelitis b. Herpes Encephalitis c. Rabies d. Arboviral Encephalitis e. HIV f. Progressive multifocal leukoencephalopathy PMLE

These cells are infected by hte JC virus (an SV 40like virus) a. Poliomyelitis b. Herpes Encephalitis c. Rabies d. Arboviral Encephalitis e. HIV f. Progressive multifocal leukoencephalopathy PMLE

This is a disturbance of neurological function caused by trauma a. Concussion b. Contusion c. Laceration d. Diffuse axonal injury e. None of the above

A. concussion

T/F you need to lose consciousness to have a concussion

FALSE

This is a superficial bruise that is confined to the GREY matter of the brain a. Concussion b. Contusion c. Laceration d. Diffuse axonal injury e. None of the above

B contusion

What is the difference between coup and countercoup lesions?

Coup: the superficial bruise at the point of impact Countercoup: the more extensive lesion on the contralteral aspect of the brain

This is an injury that extends through the gray matter into the white matter a. Concussion b. Contusion c. Laceration d. Diffuse axonal injury e. None of the above

C. laceration

This is related to the rotational forces in the brain, resulting in shearing axons a. Concussion b. Contusion c. Laceration d. Diffuse axonal injury e. None of the above

Coup + contra-coup are related to which of the following? a. Concussion b. Contusion c. Laceration d. Diffuse axonal injury e. None of the above

B. contusion

T/F Chronic Traumaitc Encephalopathy is seen in boxers and is histoloigically distinguised from alzheimers disease becuase it only has beta amyloid protein, not tau proteins

FALSE CTE has zillions of TAU (neurofibrillary tangles) NOT beta amyloid!

This part of the brain is associated with memory problems a. frontal lobes b. hippocampus c. hypothalamus d. anterior insular cortex

B hippocampus

This part of the brain is associated with emotional responses, impulsitivity and addictive behavior a. frontal lobes b. hippocampus c. hypothalamus d. anterior insular cortex e. temporal lobes

This location of the brain is associated with decision making, judgement, affect, planning, impulsivitiy a. frontal lobes b. hippocampus c. hypothalamus d. anterior insular cortex e. temporal lobes

This part of hte brain is associated with sleep disorders + stress reactions a. frontal lobes b. hippocampus c. hypothalamus d. anterior insular cortex

T/F You start to see an increase in tau proteins immediately after a TBI

False, there is a latency period

What are the myelin cells of the PNS called?

Schwann cells

How are schwann cells and oligodendrocytes different?

Schwann cells only provide myelination for ONE axon, not for adjacent axons like oligodendrocytes do

Which nerve is most commonly biopsied in order to diagnose peripheral nerve problems? a. tibial b. median c. sural d. fibular e. radial

C. sural

This is the generalized relatively homogenous process affecting many peripheral nerves. Distal portions are more typically affected most prominently a. mononeuropathy b. polyneuropathy c. mononeuropathy multiplex

This is the simultaneous or sequential involvement of non-contiguous nerve trunks a. mononeuropathy b. polyneuropathy c. mononeuropathy multiplex

Multiple nerve infarcts related to a systemic vasculitis involving the vasa nervorum is an example of what: a. mononeuropathy b. polyneuropathy c. mononeuropathy multiplex

Neuropathy or myopathy? | Distal weakness

neuropathy

Neuropathy or myopathy? | preserved reflexes

myopathy

Neuropathy or myopathy? | muscle pain is a common complaint

myopathy

Neuropathy or myopathy? | fasciculations commonly seen

neuropathy

Neuropathy or myopathy? | sensory loss

neuropathy

Neuropathy or myopathy? | dysesthesia

neuropathy

guillan barre syndrome is treated how? a. surgery b. chemotherapy c. radiation d. steroids e. good nursing care

What is the most common form of diabetic neuropathy? a. distal diabetic polyneuropathy b. diabetic multiple mononeuropathy + radiculopathy c. alcoholic polyneuropathy

This is thought to arise from the vasa nervorum - narrowing of the lumen a. distal diabetic polyneuropathy b. diabetic multiple mononeuropathy + radiculopathy c. alcoholic polyneuropathy

This is a painful asymmetric multiple neuropathy that begins as pain in the back and spreads to the thigh and knee a. distal diabetic polyneuropathy b. diabetic multiple mononeuropathy + radiculopathy c. alcoholic polyneuropathy

This type of neuropathy is mostly motor impairment a. distal diabetic polyneuropathy b. diabetic multiple mononeuropathy + radiculopathy c. alcoholic polyneuropathy

This type of neuropathy is both sensory + motor impairment a. distal diabetic polyneuropathy b. diabetic multiple mononeuropathy + radiculopathy c. alcoholic polyneuropathy

What is it called when the tumor is growing within the nerve?

a plexiform neurofibroma

What segment does wallerian degeneration occur? a. proximal b. distal c. both proximal and distal

B distal

T/F Peripheral nerves are different from central nerves in that they have the ability to reconstitute themselves

True

What is it called when a peripheral nerve is lacerated and in its attempts to regenerate, cannot meet its other half?

traumatic neuroma

What is the most common form of entrapment neuropathy? a. median nerve compression b. radial nerve compression c. ulnar nerve compression d. saturday night palsy

a- CPT

T/F Men commonly present more frequently with carpal tunnel syndrome, compared to women

False women more than men

Saturday night palsy is compression of which of the following nerves? a. median b. ulnar c. radial d. tibial e. sural

radial

What is morton's neuroma? a. a true neuroma b. a neoplastic lesion c. a traumatic nueroma d. a intermetatarsal entrapment neuropathy

This type of synapse is modulatory a. axodendritic b. axoaxonal c. axosomatic d. A and B e. B and C

This type of synapse is excitatory a. axodendritic b. axoaxonal c. axosomatic d. A and B e. B and C

This type of synapse is inhibitory a. axodendritic b. axoaxonal c. axosomatic d. A and B e. B and C

How many neurons are in the brain? a. 100 million b. 500 million c. 100 billion d. 500 billion e. 1 trillion

How much does the brain weight? a. 1.5 lbs b. 2.5 lbs c. 3.5 lbs d. 4.5 lbs e. 5.5 lbs

What is gliosis?

the deposition of glial fibers by astrocytes

What type of healing occurs with ischemic strokes?

glial scar formation + cavitation

How much CO does the brain receive from the heart? a. 10% b. 15% c. 20% d. 25% e. 30%

C. 20%

What is the true prevention of hemorrhagic stroke (intracerebral hemorrhages)? a. weight loss b. surgery c. controlling BP d. none of the above

Uncal herniation is a complication of?

intracerebral hemorrhaging

T/F Medulloblastomas fill the 4th ventricle but first fills the cerebellum

TRUE

T/F Metastatic cancer to the brain is almost invariably derived from SARCOMAS

FALSE, CARCINOMAS!!!

Where is the selective degneration in Alzheimer's? a. cerebellum b. hippocampus + nucleus basalis of meynert c. caudate + putamen d. pons e. frontal lobe of cerebrum

How many nephrons are there per kidney? a. 1 million b. 10 million c. 100 million d. 1 billion e. 100 billion